Provider Demographics
NPI:1316923832
Name:AUSTIN, LYNN A (MD PHD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:A
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 GREENLEY ROAD,
Mailing Address - Street 2:SUITE. 922
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370
Mailing Address - Country:US
Mailing Address - Phone:209-536-3738
Mailing Address - Fax:209-536-3565
Practice Address - Street 1:900 GREENLEY ROAD,
Practice Address - Street 2:SUITE. 922
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370
Practice Address - Country:US
Practice Address - Phone:209-536-3738
Practice Address - Fax:209-536-3565
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45502207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50068Medicare UPIN